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State of Washington

FINANCIAL SERVICES COUNSELOR

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FINANCIAL SERVICES COUNSELOR
148Q
Abolished Date: 2015-08-14

Class Series Concept

Determine eligibility for third-party reimbursement. Process and monitor Medical Assistance/Medicaid applications for patients.

Definition

Determine eligibility for third-party reimbursement and maintain patient account tracking system to monitor accounts.

Distinguishing Characteristics

Under general direction, contact third-party payors to obtain insurance eligibility and benefit information, estimate and collect deposits, and counsel patients regarding insurance coverage and hospital billing procedures.

Typical Work

Verify eligibility and benefits for third-party payors for planned and emergency admissions; validate prior authorizations for admission; 

Estimate hospital charges, calculate anticipated reimbursement, and determine necessary deposits; 

Counsel patients regarding their third-party coverage, financial responsibility, billing procedures; 

Obtain detailed financial information, request deposits and make referrals to Medicaid Application Unit, Hill-Burton Program, and Hospitals Collection Department; 

Review patient account summaries of unbilled charges, billings, payments and collection activity; 

Obtain all claim forms, authorizations from third-party payors and signatures required for billing within department processing standards; 

Counsel patients regarding financial arrangements for special programs and experimental protocols; 

Review and monitor accounts for inpatients; initiate process billings; 

Obtain or validate prior authorization for admission; monitor length of stay and approved days; report to Utilization Management for concurrent review activities; 

Maintain and update billing requirement tracking system; Update and maintain demographic and financial information; enter this information on-line to the central ospital database; 

Compose various correspondence related to reimbursement and billing procedures; 

Assist patients in accessing hospital and community services by consulting and making referrals to social workers, patient care coordinators, nursing liaisons, and outside agencies; 

Perform related duties as required. 

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Desirable Qualifications

Two years of college-level courses.

OR 

Two years of experience in a health care business office, medical insurance office, social services agency, or customer service position in a financial institution.

OR 

Equivalent education/experience.

Class Specification History

New Class: 12-7-90
New class code, formerly 6073 higher education, effective July 1, 2007.
Abolished; adopted August 13, 2015, effective August 14, 2015

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